Pullman Regional Hospital - Washington State Hospital ...Pullman Regional staff and identified...
Transcript of Pullman Regional Hospital - Washington State Hospital ...Pullman Regional staff and identified...
Pullman Regional Hospital
Jeannie Eylar, MSN, RN, CNO
Joy Drake, Board of Commissioners
Pullman
Regional
HospitalAdvance Care Planning
Experience
Rural Hospital Leadership Conference
June 28, 2016
Hospital dataIndicator Total 2014
ALOS 2.96
# of Inpatients# of Observation
1326700
# of Inpatient 1 day LOS
235
# of Inpatient with LOS 2-3 days
843
# of Inpatients with LOS 4-10 days
230
# of Inpatients with LOS > 10 days
18
# deaths 27
Indicator Total 2015
ALOS 2.73
# of Inpatients# of Observation
1392654
# of Inpatient 1 day LOS
218
# of Inpatient with LOS 2-3 days
859
# of Inpatients with LOS 4-10 days
319
# of Inpatients with LOS > 10 days
13
# deaths 39 (40)
06-28-2016 Rural Leadership Conference
Pullman Regional Hospital
Chart review
2013 – 32 Deaths 2015 – 39 Deaths
26* %
*1 newborn
18/26 POLST 69%
5/26 AdvanceDirective
19%
8/26 Health Care Agent
31%
33* %
*6 children <2
*2 yr old with Cancer POLST
20/33 POLST 61%
10/33 Advance
Directive
30%
9/33 Health Care Agent
27%
*32 %
17/32 POLST 53%
9/32 AdvanceDirective
28%
8/32 Health Care Agent
25%
2014 – 27 Deaths
06-28-2016 Rural Leadership Conference
Pullman Regional Hospital
Pullman Regional Hospital
Experience Nurses and social workers
experiencing moral distress trying to identify the patients wishes for care
Family members struggling to make decisions and experiencing complicated grief reactions
Physicians struggling to talk with their patients about end of life preferences
Patients struggling to talk to their family and physician about what is important to them
06-28-2016 Rural Leadership Conference
Pullman Regional Hospital
Something needed to change Collectively there was a
strong sense that how, when and where conversations about end of life care needed to change
Meeting a patient for the first time when they are in the ICU on a ventilator is not the time to start a conversation about patient preference for treatment
How do we know what the patients’ wishes are? How do we ensure known wishes are honored? How can we move this conversation upstream?
Quality of Life Team formed 2008
06-28-2016 Rural Leadership Conference
Pullman Regional Hospital
Community Collaboration & Steering
Committee – Summer 2013
Invited 45 people to attend a presentation on how Gundersen Health System has created a model of standardized advance care planning that satisfies patients’ wishes, eases family concerns, and lowers end-of-life care costs.
Explore ways and benefits of engaging the broader community in advance care planning and training.
06-28-2016 Rural Leadership Conference
Pullman Regional Hospital
Engage the broader community in advance care planning and training
Join with primary care and the community for a unified approach and ACP process
Seek critical support from local faith, business, and social service agencies Countywide
selection/invitation
Nurses (hospital based and primary care), social workers, hospice volunteers, physician, volunteer chaplains, church leaders, EMT, mental health, SNF Administrator, Case Managers, Librarian, primary care practice manager, hospital board members
Train community volunteers and professionals to have initial ACP conversations with friends, family, and neighbors (circles of influence)
October 2014
06-28-2016 Rural Leadership Conference
Pullman Regional Hospital
Atul Gawade book
Being Mortal
Released October
2014
PBS special
available for
viewing -www.honoringchoicespnw.org/
06-28-2016 Rural Leadership Conference
Pullman Regional Hospital
Who, When, and What for advance care
conversations
Use a phased approach to ACP that
engages patients at the right times in their
illness and wellness
Redefine physician and clinical team roles
in advance care conversations
Teach and measure the skills for effective,
compassionate conversations with patients
and their families
06-28-2016 Rural Leadership Conference
Pullman Regional Hospital
Use systems design and continuous quality
improvement to standardize advance care
planning
Develop communication (common
language), structure, and leadership
support for consistent, standardized
advance care planning
Use quality improvement to drive results
and measure success
Effectively use the EHR platform to prompt
ACP at the point of care
06-28-2016 Rural Leadership Conference
Pullman Regional Hospital
Honoring Choices
Pacific Northwest
Implementation
Plan Pullman Regional
Hospital partnered with Pullman Family Medicine
Physician Champion
Shared IT support
Physician Invite and referral generated to ACP Facilitator
Utilize clinical staff and volunteers
Docuware accessible to Pullman Regional staff and identified clinical staff with Pullman Family Medicine
06-28-2016 Rural Leadership Conference
Pullman Regional Hospital
Advance care
planning is a
process of
communication
that helps you
understand, reflect
upon and discuss
your goals, values
and beliefs for
future health care
decisions.
Who will speak
for you?
06-28-2016 Rural Leadership Conference
Pullman Regional Hospital